Eye Therapy System

ABSTRACT

Embodiments apply a cross-linking agent to a region of corneal tissue. The cross-linking agent improves the ability of the corneal tissue to resist undesired structural changes. For example, the cross-linking agent may be Riboflavin or Rose Bengal, and the initiating element may be photoactivating light, such as ultraviolet (UV) light. In these embodiments, the photoactivating light initiates cross-linking activity by irradiating the applied cross-linking agent to release reactive oxygen radicals in the corneal tissue. The cross-linking agent acts as a sensitizer to convert O 2  into singlet oxygen which causes cross-linking within the corneal tissue. The rate of cross-linking in the cornea is related to the concentration of O 2  present when the cross-linking agent is irradiated with photoactivating light. Accordingly, the embodiments control the concentration of O 2  during irradiation to increase or decrease the rate of cross-linking and achieve a desired amount of cross-linking.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims priority to U.S. Provisional Application No.61/253,736, filed Oct. 21, 2009, the contents of which are incorporatedentirely herein by reference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The invention pertains to the field of conducting eye therapy, and moreparticularly, to systems and methods for stabilizing changes to cornealtissue as a part of eye therapy.

2. Description of Related Art

A variety of eye disorders, such as myopia, keratoconus, and hyperopia,involve abnormal shaping of the cornea. Laser-assisted in-situkeratomileusis (LASIK) is one of a number of corrective procedures thatreshape the cornea so that light traveling through the cornea isproperly focused onto the retina located in the back of the eye. DuringLASIK eye surgery, an instrument called a microkeratome is used to cut athin flap in the cornea. The corneal flap is then peeled back and theunderlying corneal tissue is ablated to the desired shape with anexcimer laser. After the desired reshaping of the cornea is achieved,the corneal flap is put back in place and the surgery is complete.

In another corrective procedure that reshapes the cornea,thermokeratoplasty provides a noninvasive procedure that applieselectrical energy in the microwave or radio frequency (RF) band to thecornea. In particular, the electrical energy raises the cornealtemperature until the collagen fibers in the cornea shrink at about 60°C. The onset of shrinkage is rapid, and stresses resulting from thisshrinkage reshape the corneal surface. Thus, application of energyaccording to particular patterns, including, but not limited to,circular or annular patterns, causes aspects of the cornea to flattenand improves vision in the eye.

The success of procedures, such as LASIK or thermokeratoplasty, inaddressing eye disorders, such as myopia, keratoconus, and hyperopia,depends on whether the desired reshaping of the cornea has beensufficiently stabilized.

SUMMARY OF THE INVENTION

Embodiments according to aspects of the present invention providesystems and methods for stabilizing corneal tissue and improving itsbiomechanical strength. For example, the embodiments may be employed topreserve the desired reshaping of corneal tissue produced by eyetherapies, such as thermokeratoplasty or LASIK surgery.

In particular, the embodiments apply a cross-linking agent to a regionof corneal tissue. The cross-linking agent improves the ability of thecorneal tissue to resist undesired structural changes. For example, thecross-linking agent may be Riboflavin or Rose Bengal, and the initiatingelement may be photoactivating light, such as ultraviolet (UV) light. Inthese embodiments, the photoactivating light initiates cross-linkingactivity by irradiating the applied cross-linking agent to releasereactive oxygen radicals in the corneal tissue. The cross-linking agent,e.g. Riboflavin or Rose Bengal, acts as a sensitizer to convert O₂ intosinglet oxygen which causes cross-linking within the corneal tissue.

The rate of cross-linking in the cornea is related to the concentrationof o₂ present when the cross-linking agent is irradiated withphotoactivating light. Accordingly, aspects of the present inventioncontrol the concentration of O₂ during irradiation to increase ordecrease the rate of cross-linking and achieve a desired amount ofcross-linking.

To increase the presence of O₂ during irradiation, the cross-linkingagent in some embodiments may be saturated or supersaturated with O₂before application to the cornea.

In other embodiments, a steady state of O₂ may be maintained above theeye to expose the cornea to higher concentrations of O₂ duringirradiation.

In further embodiments, a gel, such as a methylcellulose gel, may besaturated or supersaturated with O₂. The gel acts as a carrier for O₂.The gel may then be applied to the cornea after the cross-linking agenthas been applied to the cornea. Alternatively, the gel may be mixed withthe cross-linking agent before the cross-linking agent is applied to thecornea.

In some embodiments, the rate of cross-linking may be monitored in realtime and the concentration of O₂ may be dynamically increased ordecreased to achieve a desired amount of cross-linking. Thus,embodiments include a system that provides a first amount of O₂ abovethe eye to introduce O₂ to the corneal tissue and expose the cornea to afirst concentration of O₂ during irradiation. Based on the feedback fromthe real time monitoring, the system can then provide a second amount ofO₂ above the eye to introduce another amount of O₂ to the corneal tissueand expose the cornea to a second concentration of O₂ duringirradiation. The first amount of O₂ may be greater than the secondamount of O₂, or vice versa. Changing the cornea's exposure from thefirst concentration to the second concentration changes the rate ofcross-linking in the corneal tissue. Further changes to theconcentration of O₂ during irradiation may be effected to control therate of cross-linking. When necessary, the amount of O₂ above the eyemay be substantially reduced to zero to prevent further introduction ofO₂ to the corneal tissue during irradiation.

Other aspects, features, and advantages of the present invention arereadily apparent from the following detailed description, byillustrating a number of exemplary embodiments and implementations,including the best mode contemplated for carrying out the presentinvention. The present invention is also capable of other and differentembodiments, and its several details can be modified in variousrespects, all without departing from the spirit and scope of the presentinvention. Accordingly, the drawings and descriptions are to be regardedas illustrative in nature, and not as restrictive. The invention is tocover all modifications, equivalents, and alternatives falling withinthe spirit and scope of the invention.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A illustrates a high resolution image of a cornea after energy hasbeen applied.

FIG. 1B illustrates another high resolution images of the cornea of FIG.1A.

FIG. 1C illustrates a histology image of the cornea of FIG. 1A.

FIG. 1D illustrates another histology image of the cornea of FIG. 1A.

FIG. 2A illustrates an example approach for stabilizing or strengtheningcorneal tissue by applying a cross-linking agent according to aspects ofthe present invention.

FIG. 2B illustrates an example approach for stabilizing or strengtheningcorneal tissue by applying Riboflavin as a cross-linking agent accordingto aspects of the present invention.

FIG. 3A illustrates an example device that may be employed tosupersaturate a cross-linking agent with O₂ according to aspects of thepresent invention.

FIG. 3B illustrates an example approach for stabilizing or strengtheningcorneal tissue by applying supersaturated Riboflavin as a cross-linkingagent according to aspects of the present invention.

FIG. 4A illustrates an example device that may be employed tosupersaturate a carrier gel with O₂ according to aspects of the presentinvention.

FIG. 4B illustrates an example approach for stabilizing or strengtheningcorneal tissue by mixing Riboflavin with a gel supersaturated with O₂according to aspects of the present invention.

FIG. 4C illustrates an example approach for stabilizing or strengtheningcorneal tissue by applying a gel supersaturated with O₂ according toaspects of the present invention.

FIG. 5A illustrates an example device that may be employed maintain asteady state of O₂ above the eye to expose the cornea to higherconcentrations of O₂ according to aspects of the present invention.

FIG. 5B illustrates another example device that may be employed tomaintain a steady state of O₂ above the eye to expose the cornea tohigher concentrations of o₂ according to aspects of the presentinvention.

FIG. 5C illustrates an example approach for stabilizing or strengtheningcorneal tissue by applying a state of O₂ above the eye to expose thecornea to higher concentrations of O₂.

FIG. 6 illustrates an example approach for stabilizing or strengtheningcorneal tissue by monitoring cross-linking activity in real time andcontrolling the amount of O₂ exposure to achieve desired rates ofcross-linking according to aspects of the present invention.

DETAILED DESCRIPTION

Embodiments according to aspects of the present invention providesystems and methods for stabilizing corneal tissue and improving itsbiomechanical strength. For example, the embodiments may be employed topreserve the desired reshaping of corneal tissue produced by eyetherapies, such as thermokeratoplasty or LASIK surgery.

FIGS. 1A-D illustrate an example of the effect of applying heat tocorneal tissue with thermokeratoplasty. In particular, FIGS. 1A and 1Billustrate high resolution images of cornea 2 after heat has beenapplied. As FIGS. 1A and 1B show, a lesion 4 extends from the cornealsurface 2A to a mid-depth region 2B in the corneal stroma 2C. The lesion4 is the result of changes in corneal structure induced by theapplication of heat as described above. These changes in structureresult in an overall reshaping of the cornea 2. It is noted that theapplication of heat, however, has not resulted in any heat-relateddamage to the corneal tissue.

As further illustrated in FIGS. 1A and 1B, the changes in cornealstructure are localized and limited to an area and a depth specificallydetermined by the controlled application of heat. FIGS. 1C and 1Dillustrate histology images in which the tissue shown in FIGS. 1A and 1Bhas been stained to highlight the structural changes induced by theheat. In particular, the difference between the structure of collagenfibrils in the mid-depth region 2B where heat has penetrated and thestructure of collagen fibrils outside the region 2B is clearly visible.Thus, the collagen fibrils outside the region 2B remain generallyunaffected by the application of heat, while the collagen fibrils insidethe region 2B have been rearranged and formed new bonds to createcompletely different structures. In other words, unlike processes, suchas orthokeratology, which compress areas of the cornea to reshape thecornea via mechanical deformation, the collagen fibrils in the region 2Bare in an entirely new state. Treatment of the cornea producesstructural changes to the stroma 2C, and the optomechanical propertiesof the cornea change under stress. Such changes include: straighteningout the waviness of the collagen fibrils; slippage and rotation ofindividual lamellae; and breakdown of aggregated molecularsuperstructures into smaller units.

Although treatments, such thermokeratoplasty, may initially achievedesired reshaping of the cornea, the desired effects of reshaping thecornea may be mitigated or reversed at least partially if the collagenfibrils continue to change after the desired reshaping has beenachieved. Therefore, aspects of the present invention provide approachesfor preserving the desired corneal structure and shape that result froman eye therapy, such as thermokeratoplasty. In general, embodimentsprovide approaches for initiating molecular cross-linking of the cornealcollagen to stabilize the corneal tissue and improve its biomechanicalstrength.

Referring to FIG. 2A, a treatment, such as thermokeratoplasty or LASIKsurgery, is applied in step 210 to generate structural changes in thecornea and produce a desired shape change. In step 220, the cornealtissue is treated with a cross-linking agent 222. The cross-linkingagent may be applied directly on the treated tissue and/or in areasaround the treated tissue. In some embodiments, the cross-linking agentmay be an ophthalmic solution that is broadly delivered by a dropper,syringe, or the like. Alternatively, the cross-linking agent may beselectively applied as an ophthalmic ointment with an appropriateointment applicator. The cross-linking agent 222 is then activated instep 230 with an initiating element 232. Activation of the cross-linkingagent 222, for example, may be triggered thermally by the application ofmicrowaves or light from a corresponding energy or light source. Theresulting cross-linking between collagen fibrils provides resistance tochanges in corneal structure.

As described previously with reference to FIGS. 1A-D, for example, thelesion 4 extends from the corneal surface 2A to a mid-depth region 2B inthe corneal stroma 2C. In such cases, the application of thecross-linking agent in step 220 introduces sufficient amounts ofcross-linking agent to mid-depth regions of the corneal tissue wherestronger and more stable structure is desired.

As FIG. 2B shows further, Ribloflavin is applied as a cross-linkingagent 222′ to the corneal tissue in step 220. In addition, light from aultraviolet (UV) light source may be applied as an initiating element232′ in step 230 to initiate cross-linking in the corneal areas treatedwith Ribloflavin. Specifically, the UV light initiates cross-linkingactivity by causing the applied Riboflavin to release reactive oxygenradicals in the corneal tissue. The Riboflavin acts as a sensitizer toconvert O₂ into singlet oxygen which causes cross-linking within thecorneal tissue.

In human tissue, O₂ content is very low compared to the atmosphere. Therate of cross-linking in the cornea, however, is related to theconcentration of O₂ when it is irradiated with photoactivating light.Therefore, it may be advantageous to increase or decrease theconcentration of O₂ actively during irradiation to control the rate ofcross-linking until a desired amount of cross-linking is achieved.

An approach according to aspects of the present invention involvessupersaturating the Riboflavin with O₂. Thus, when the Riboflavin isapplied to the eye, a higher concentration of O₂ is delivered directlyinto the cornea with the Riboflavin and affects the conversion of O₂into singlet oxygen when the Riboflavin is exposed to thephotoactivating light. As illustrated in FIG. 3A, the Riboflavin 222′may be stored in a closed vessel, e.g., a vial, 300 under increased O₂pressure 305. The increased O₂ pressure 305 results in a higherequilibrium concentration of O₂ in the Riboflavin 222′. The walls 310 ofthe vessel 300 are preferably opaque or otherwise prevent visible, UV,or other light from entering the vessel interior 301 to minimize thedegradation of the Riboflavin 222′. Accordingly, referring to FIG. 3B,the step 215 supersaturates the Riboflavin 222′ with O₂ so that asupersaturated Riboflavin 222′ is applied in step 220.

According to other aspects of the present invention, rather thansupersaturating the Riboflavin 222′ with O₂, another substance, such asa gel (e.g., a methylcellulose gel), may be saturated or supersaturatedwith O₂. As illustrated in FIG. 4A, a gel 421 may be stored in aninterior 401 of a closed vessel, e.g., a vial, 400 under increased O₂pressure 405. The increased O₂ pressure 405 results in a higherequilibrium concentration of O₂ in the gel 421. The gel can then act asa carrier for O₂.

Referring to FIG. 4B, step 216 saturates a gel 421 with O₂, and step 217mixes the supersaturated gel 421 with the Riboflavin 222′, so that amixture 422 containing the Riboflavin 222′ and the supersaturated gel421 is applied in step 220. Alternatively, referring to FIG. 4C, step216 saturates a gel 421 with O₂, and step 225 applies the gel 421 to thecornea after the Riboflavin 222′ has been applied to the cornea. In bothFIGS. 4A and 4B, the gel 421 increases the presence of O₂ when theRiboflavin 222′ is activated with the UV light.

According to additional aspects of the present invention, a steady stateof O₂ may be maintained at the surface of the cornea to expose thecornea to a selected amount of O₂ and cause O₂ to enter the cornea. Thephotoactivating light can then be applied to a cornea with the desiredO₂ content.

As shown in FIG. 5A, a ring 500 is placed on the eye 1 to supply O₂ tothe cornea 2 during irradiation. The ring 500 includes one or more ports502 that direct a steady flow of O₂ to the cornea 2, which has beentreated by Riboflavin. The flow applies O₂ at high pressure against thecornea 2, so that more O₂ is available during the irradiation of theRiboflavin in the corneal tissue. The ring 500 may optionally be held inplace by suction.

As FIG. 5B illustrates, in another embodiment, an enclosure 510receiving a supply of O₂ through a port 512 is placed on the eye toestablish a steady state of O₂. The enclosure 510 may be held in placeby a suction ring 512. As shown in FIG. 5B, the enclosure 510 may be acup-like structure. The enclosure 510 maintains the O₂ at a higherpressure, e.g., higher than ambient, against the surface of the cornea2. The concentration of O₂ within the enclosure 510 and above thesurface of the cornea 2 can approach 100%. The O₂ within the enclosure510 makes more O₂ to be available for the irradiation of the Riboflavinin the corneal tissue. At least a portion of the walls 514 of theenclosure 510 may be translucent to allow photoactivating light to passthrough the enclosure 510 to irradiate the cornea 2 and activate theRiboflavin applied to the cornea 2. Alternatively, the light source maybe disposed within the enclosure. The enclosure 510 may also include avalve that allows the gas to be released.

Accordingly, referring to FIG. 5C, step 227 establishes a steady stateof O₂ above the corneal surface before the photoactivating light 232′ isapplied in step 230 to initiate cross-linking with the Riboflavin 222′.

Referring to FIG. 6, the rate of cross-linking may be monitored in realtime and the concentration of O₂ may be dynamically increased ordecreased to achieve a desired amount of cross-linking. As FIG. 6illustrates, corneal tissue is treated with Riboflavin 222′ in step 220.In step 228, a first amount of O₂ is provided above the corneal surfaceto introduce O₂ to the corneal tissue and establish a firstconcentration of O₂ in the cornea during irradiation. The devicesdescribed with reference to FIGS. 5A and 5B may be employed to changethe amount of O₂ is provided above the corneal surface. The Riboflavin222′ is then activated in step 230 with UV light 232′.

In step 240, the amount of cross-linking resulting from the activationof the Riboflavin 222′ is monitored. One technique for monitoring thecross-linking employs polarimetry to measure corneal birefringence andto determine the structure of the corneal tissue. In particular, thetechnique measures the effects of cross-linking on corneal structure byapplying polarized light to the corneal tissue. The corneal stroma isanisotropic and its index of refractions depends on direction. Thecornea behaves like a curved biaxial crystal with the fast axisorthogonal to the corneal surface and the slow axis (or cornealpolarization axis) tangential to the corneal surface. Accordingly, alight beam emerging from the living eye after a double pass through theocular optics contains information on the polarization properties of theocular structures (except optically inactive humours). The technique ofusing birefringence to monitor the structural changes resulting fromcross-linking is described further in U.S. Provisional PatentApplication No. 61/388,963, filed Oct. 1, 2010, the contents of whichare entirely incorporated herein by reference. A controller, employingconventional computer hardware or similar processing hardware, can beused to monitor the amount of cross-linking. Such hardware may operateby reading and executing programmed instructions that are stored orfixed on computer-readable media, such as conventional computer disk. Inaddition to being coupled to monitoring hardware, the controller may becoupled to, and automatically control, the device(s) that provide the O₂above the corneal surface.

Based on the information from the real time monitoring in step 240, step250 provides a second amount of O₂ above the eye to introduce anotheramount of O₂ to the corneal tissue and expose the cornea to a secondconcentration of O₂ during irradiation with UV light 232′ in step 260.Steps 240, 250, and 260 may be repeated any number of times to changethe concentration of O₂ during irradiation to control the rate ofcross-linking dynamically.

The first amount of O₂ in step 228 may be greater than the second amountof O₂ in step 250, or vice versa. Changing the cornea's exposure fromthe first concentration to the second concentration changes the rate ofcross-linking in the corneal tissue as desired. If the information fromstep 240 indicates that the first amount of O₂ is too low, step 250provides a second amount of O₂ that is greater than the first amount ofO₂. On the other hand, if the information from step 240 indicates thatthe first amount of O₂ is too high, step 250 provides a second amount ofO₂ that is greater than the first amount of O₂. It may be necessary toremove the first amount of O₂, e.g., from the enclosure 510, beforeproviding the second amount of O₂ in step 250.

In some cases, it may be desired to provide substantially zero O₂ instep 250 to minimize or reduce the amount of O₂ in the corneal tissueduring irradiation in step 260. Accordingly, step 250 may introduce anon-O₂ element or substance above the corneal surface. For example,nitrogen gas (N₂) may replace the O₂ supplied by the devices 500 and 510shown in FIGS. 5A and 5B.

Although the embodiments described above may employ Riboflavin as across-linking agent, it is understood that other substances may beemployed as a cross-linking agent. Thus, an embodiment may employ RoseBengal (4,5,6,7-tetrachloro-2′,4′,5′,7′-tetraiodofluorescein) as across-linking agent (similar to the embodiment of FIG. 3B). Rose Bengalhas been approved for application to the eye as a stain to identifydamage to conjunctival and corneal cells. However, Rose Bengal can alsoinitiate cross-linking activity within corneal collagen to stabilize thecorneal tissue and improve its biomechanical strength. Like Riboflavin,photoactivating light 332′ may be applied to initiate cross-linkingactivity by causing the Rose Bengal to convert O₂ in the corneal tissueinto singlet oxygen. The photoactivating light 332′ may include, forexample, UV light or green light.

Thus, with Rose Bengal, the rate of cross-linking in the cornea isrelated to the concentration of O₂ when it is irradiated withphotoactivating light. Therefore, it may be advantageous to increase ordecrease the concentration of O₂ during irradiation to control the rateof cross-linking and achieve the desired cross-linking. Theconcentration of O₂ may be increased or decreased according to thetechniques described previously. For example, the Rose Bengal may besaturated or supersaturated with O₂ before application to the cornea.Additionally or alternatively, a steady state of O₂ may be maintainedabove the eye to expose the cornea to higher concentrations of O₂ andcause O₂ to enter the cornea. In general, the O₂ content in the corneamay be controlled for more effective cross-linking for any agent thatoperates to produce a reactive oxygen species for cross-linking.

Although aspects of the present invention have been described inconnection with thermokeratoplasty or LASIK surgery, it is understoodthat the systems and methods described may be applied in other contexts.In other words, it may be advantageous to stabilize corneal structurewith a cross-linking agent as described above as a part of anytreatment.

While the invention is susceptible to various modifications andalternative forms, specific embodiments and methods thereof have beenshown by way of example in the drawings and are described in detailherein. It should be understood, however, that it is not intended tolimit the invention to the particular forms or methods disclosed, but,to the contrary, the intention is to cover all modifications,equivalents and alternatives falling within the spirit and scope of theinvention.

1. A system for controlling cross-linking in corneal tissue, comprising:an applicator that applies a cross-linking agent to a cornea; a lightsource that provides photoactivating light to the cornea and activatesthe cross-linking agent, the cross-linking agent producing reactivesinglet oxygen from O₂ content in the cornea, the singlet oxygen causingcross-linking in corneal fibrils to preserve a structure of the cornea;and a delivery device that provides a gas mixture at steady state at asurface of the cornea, the gas mixture determining the O₂ content foractivation of the cross-linking agent in the cornea. 2-28. (canceled)